Biomedical subjects
Publications and source records attributed to A Hawasli.
Laparoscopic cholecysto-jejunostomy was performed on two patients with obstructive jaundice due to a mass in the head of the pancreas. Diagnostic studies included CT scan, ERCP, arteriogram, and percutaneous needle aspiration cytology. Both patients recovered without event and were discharged after 4 days.
Laparoscopic inguinal herniorrhaphy was performed on 76 patients with a total of 82 hernias. A modified Schultz repair was done using a mushroom-shaped mesh plug. The flat piece of this plug acts as a stopper to prevent migration of the plug into the inguinal canal or the subcutaneous tissue (in the direct hernia, primary or recurrent). Average operative time was 69 min (range 42-140 min). Short-term follow-up of 1 to 7 months showed no recurrence and good acceptance of the repair by patients.
Routine drainage was adopted in laparoscopic cholecystectomy since we started to perform this operation, in November 1989. Its use was triggered by a fear of complications that might require an open operation. Between November 1989 and June 1991, 480 elective procedures were performed. Bile drainage was encountered in five patients and bleeding in three patients. None of the patients with bile drainage developed bile peritonitis or required reoperation; one patient with bleeding required reoperation. Complaint of shoulder pain was minimal (4.8%).
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Laparoscopic cholecystectomy was first performed at Saint John Hospital in November 1989. This is a study of the first 50 patients operated on between November 1989 and March 1990. This new technique, which requires different eye-hand coordination and deals with new instruments, prompted an analysis of the first 25 patients (Group 1) vs the second 25 patients (Group 2) for complications, hospital stay, and operating time. All patients were candidates for elective cholecystectomy. There were 32 women and 18 men with an average age of 51 years (range of 20-72 years). There was an average weight of 174 lb (range of 107-265 lb). Group 1 had three minor complications: bile drainage (1), nausea (1), and pain (1). Group 2 only had one minor complication: nausea. Group 1 had four major complications: bile leak from the cystic duct (1), conversion to open cholecystectomy for bleeding (1), reoperation for control of liver oozing in an unsuspected cirrhotic (1), and common duct injury (1). Group 2 had no major complications. The hospital stay was 2.33 days (range of 1-13 days) and 1.04 days (range of 1-3 days) and the operating time was 134 minutes (range of 75-200 min) and 78 minutes (range of 50-150 min) for Group 1 and Group 2, respectively. Sixteen Group 1 patients (64%) and 24 Group 2 patients (96%) were outpatients. Significantly fewer complications, shorter hospital stay, and decreased operating time in Group 2 emphasize the importance of the learning experience.
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The question of what constitutes an adequate axillary dissection for breast cancer remains open for debate. Central to this controversy is whether axillary nodal metastasis occurs in a stepwise fashion or spreads sporadically, creating skip metastases. The therapeutic aim of axillary dissection also must be considered. To resolve this controversy, a prospective study involving 129 patients who underwent complete axillary dissection for breast carcinoma was performed. The tissue from the axillary dissections was divided intraoperatively and sent to the pathologist as two specimens. The first specimen contained all nodes lateral to the pectoralis minor muscle (Level I), whereas the second contained all nodes beneath and medial to the pectoralis minor (Levels II and III). The tissue was analyzed to determine the frequency of skip metastasis. Only two patients, 1.6 per cent of the total group or 3.2 per cent of the positive node group, were found to have a positive node in Level II-III with no metastasis in Level I. A thorough dissection of Level I alone is sufficient to detect more than 98 per cent of all axillary lymph node metastases from breast cancer. Thus, proper staging of the disease can be obtained. When Level I contained positive nodes, the probability of metastatic disease to higher levels was significant (45%), indicating further treatment is necessary in incomplete axillary dissections.
An unusual case in which a complete bilateral ureteral transection due to a single low velocity gunshot wound occurred. This case illustrates that in gunshot wounds to the abdomen involving the retroperitoneum, ureteral inspection is imperative especially in view of the fact that preliminary diagnostic workup during trauma resuscitation may be inadequate.